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The Effect of Different Attribution Rules on Individual Physician Cost Profiles

Ateev Mehrotra, MD, MPH; John L. Adams, PhD; J. William Thomas, PhD; and Elizabeth A. McGlynn, PhD
[+] Article, Author, and Disclosure Information

From the RAND Corporation, Santa Monica, California, and Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania; and University of Southern Maine, Portland, Maine.

Acknowledgment: The authors thank Barbra Rabson and Jan Singer of Massachusetts Health Quality Partners, who facilitated access to the data sets used in this study.

Grant Support: By a contract from the U.S. Department of Labor (J-9-P-2-0033); a career development award (KL2 RR024154) from the National Center for Research Resources, a component of the National Institutes of Health (Dr. Mehrotra); and grant 60517 from the Robert Wood Johnson Foundation's Health Care Financing and Organization program (Dr. Thomas).

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-2756.

Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Mehrotra (mehrotra@rand.org). Data set: Available through written agreements with the authors, Massachusetts Health Quality Partners, and the health plans that provided the data.

Requests for Single Reprints: Ateev Mehrotra, MD, MPH, RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665; e-mail, mehrotra@rand.org.

Current Author Addresses: Dr. Mehrotra: RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2655.

Drs. Adams and McGlynn: RAND, 1776 Main Street, Box 2138, Santa Monica, CA 90407.

Dr. Thomas: Box 9300, 509 Forest Avenue, Portland, ME 04104-9300.

Author Contributions: Conception and design: A. Mehrotra, J.L. Adams, J.W. Thomas, E.A. McGlynn.

Analysis and interpretation of the data: A. Mehrotra, J.L. Adams, J.W. Thomas, E.A. McGlynn.

Drafting of the article: A. Mehrotra, J.W. Thomas.

Critical revision of the article for important intellectual content: J.L. Adams, E.A. McGlynn.

Final approval of the article: A. Mehrotra, J.L. Adams, J.W. Thomas, E.A. McGlynn.

Statistical expertise: J.L. Adams.

Obtaining of funding: E.A. McGlynn.

Administrative, technical, or logistic support: A. Mehrotra.

Collection and assembly of data: A. Mehrotra, E.A. McGlynn.

Ann Intern Med. 2010;152(10):649-654. doi:10.7326/0003-4819-152-10-201005180-00005
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Our study sample included 13 761 physicians, who delivered 5 602 652 episodes of care to 1.1 million patients. For most patients and episodes, care involved multiple physicians. Among patients, 91% saw multiple physicians over the 2-year period and 61% saw 5 or more physicians. Among episodes, 54% involved multiple physicians and 9% involved 5 or more physicians.

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